Provider Demographics
NPI:1750688487
Name:MOYA-HERRERA, ROSITA (LMSW)
Entity Type:Individual
Prefix:
First Name:ROSITA
Middle Name:
Last Name:MOYA-HERRERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 1300
Mailing Address - Street 2:119 LUNA AVENUE
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031
Mailing Address - Country:US
Mailing Address - Phone:505-866-8338
Mailing Address - Fax:505-866-2180
Practice Address - Street 1:1330 SAN PEDRO DR NE
Practice Address - Street 2:SUITE 201-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6744
Practice Address - Country:US
Practice Address - Phone:505-260-9912
Practice Address - Fax:505-260-9934
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-05024101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor